Spring Garden Waldorf School
SPRINGGARDENWALDORFSCHOOL
1791 SOUTH JACOBY ROAD COPLEY, OHIO44321
ENROLLMENT APPLICATION
I am interested in enrolling my child in SpringGardenWaldorfSchool for the ______school year
in the following class (please circle):Preschool 3 Full Days 3 Half Days 5 Full Days 5 Half Days
Kindergarten* 5 Full Day 5 Half Days
Grade School: 1** 2 3 4 5 6 7 8
*Kindergarten children must be 5 no later than June 1. **First grade children must be 6 no later than June 1.
Date of birth will be a factor in the placement of children in all grades
Student's Full Name Name to be used in school ______
Last First M.I.
Address ______
Number & Street City/State/Zip Home Phone # Email Address
Birthdate / / Age Grade Sex: M F Social Security # ______
Father's Name Mother's Name ______
Address Address ______
Zip Zip ______
Phone Phone ______
Social Security # ______Social Security # ______
Occupation Occupation ______
Employer Employer ______
Work Phone Work Phone ______
Marital Status Marital Status ______
Do both parents reside in the home? If not, does child have contact with both? ______
How much time is spent in each environment? ______
Who is financially responsible for school expenses? ______
Is there anyone else at home who shares responsibility for the child?______
Name Relationship ______
Does child have siblings? (include names, birthdates, and schools attending) ______
Do you have any relatives and/or friends at SpringGardenWaldorfSchool? ______
How did you learn about SpringGardenWaldorfSchool? ______
To what other schools have you applied? ______
A limited amount of tuition assistance is available. Will you be applying for financial aid? YES NO
CHILD'S EARLY HISTORY
Note to parents: We request the following information so that we may obtain as complete a picture as possible of the developmental
stages of the children that come under our care, thus enabling us to serve the needs of the child and family to the best of our ability.
Please use additional paper if necessary. All information will be kept confidential.
How old was mother when child was born? father? Place of birth: ______
How was the pregnancy? ______
Hospital or home birth? If any, what family and friends were present? ______
How was the birth? (e.g.. easy, quick, long, caesarian etc.) ______
If child was adopted, at what age and under what circumstances? ______
Birth weight Was child breast-fed? How long? ______
At what age did child: crawl? walk? speak? begin referring to him/herself as "I"? _____
When was child toilet-trained? Does child wet the bed? Under what circumstances? ______
Does child suck thumb or fingers? Any other habits? (nail biting, hair twisting, etc.) ______
Are there any letters or sounds child does not yet speak clearly? (such as R, Y, D?) ______
Were there any complications or extraordinary events in the first 3 years of the child's life? Please explain:
______
Please describe any early learning programs your child has been involved in:
______
HOME & FAMILY RHYTHMS
What time does child awake in the morning on weekdays? Weekends? ______
How does child awaken (dreamy, crabby, cheery, etc.)? ______
What, if anything, does child eat for breakfast? ______
Do you or your child follow any special diet? Allergies? ______
What foods does your child like most? Least? ______
What meals does child have with the entire family? What time are the meals? ______
What, if any, are child's regular chores? ______
How do you discipline your child? (give examples) ______
How would you describe your child's temperament? ______
What time does child go to bed on weekdays? Weekends? ______
What, if any, is the bedtime ritual? ______Does child fall asleep easily? ______
Does s/he sleep through the night? Any recurring nightmares or dreams? ______
What are your family’s weekend activities?______
Is routine and rhythm important in your child's life? If so, what do you do to provide it? ______
What language is spoken in the home? What languages does the child speak? ______
Other than immediate family, are there any other people who are major influences in the child's life?
______
Describe home life or attitudes that you consider to be different or unique:
______
What festivals does your family celebrate? ______
PLAY
What activities does your family do together that your child enjoys? ______
What physical activities does your child enjoy? ______
Does your child get hot or cold easily? Do you mind your child getting dirty during play? ______
Does your child use a computer or computer games? How often? ______
Does your child watch TV or videos? When? How long? hrs/week
What programs? ______
What kind of music do you and your child listen to at home? ______
Do you play radio or tapes in the car? ______
Are you willing to limit your child's T.V. viewing, video game/computer use and listening time? ______
If child has siblings, describe their relationship and play: ______
What kinds of pets, if any, does your child have? ______
Does your child have friends in your neighborhood? What are their ages? ______
Describe their relationship and play: ______
What kind of play and toys does s/he enjoy most? Least? ______
Is there a special toy or doll? ______
What is your child's outdoor play environment? ______
What, if any, extra classes outside of school does your child take? ______
Where will your child be after school? (with parent, babysitter, other home, aftercare, ect.) ______
ACADEMIC & MEDICAL HISTORY
Please explain any learning difficulties child may have. ______
Has the child received psychological or psychiatric evaluations or counseling? Yes No If yes, please explain (include duration):
______
Has the child received special medical tests or treatments? Yes No If yes, please explain (include duration):
______
Will the results be available to SpringGarden? Yes No If no, please explain:
Name of school presently attending: ______
Address: ______
City ______State ______Zip ______
Names of all schools attended prior to present school ______
______
Does the child currently have an I.E.P.? ______
Is there anything you feel is pertinent to your child's biography that has not been covered above? (e.g. special interests or abilities,
physical characteristics and behavioral, medical or emotional problems to overcome, academic strength, and weaknesses).
If you are transferring your child, you may wish to include your reasons for doing so. Please continue on another sheet of paper
if needed
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What are you hoping to find in this education for your child?
______
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SpringGardenWaldorfSchool is a non-profit, non-discriminatory educational organization,welcoming children from
preschool through grade eight of all races, religions and national origins.SpringGardenWaldorfSchool is chartered in
the State of Ohio.
A non-refundable application fee of $70.00 is required upon submission of this application.
Application and fee (payable to SGWS) may be mailed to:
SpringGardenWaldorfSchool
1791 South Jacoby Road
Copley, Ohio44321
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Signature of Parent/Guardian Date
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Signature of Parent/Guardian Date